**1. Introduction**

Diabetes mellitus (DM), a very complex and heterogeneous chronic disease, is associated with chronic complications generated by alteration of the endothelium at all arterial vascular territory levels. The micro-and macrovascular complications affect the entire body; their pathogenic mechanisms are intricate and involve multiple pathways and risk factors. The main risk factors are insulin resistance/hyperinsulinemia, hyperglycemia, dyslipidemia, hypercholesterolemia, hypertension, smoking, obesity/overweight, all of which cause endothelial dysfunction. Consequently, they appear vasoconstriction, oxidative stress, subclinical inflammation, vascular calcification and thrombosis, essential pathogenic elements in the process of atherogenesis/macroangiopathy and microangiopathy [1].

Cardiovascular disease is considered a major cause of morbidity and mortality among people with diabetes, with a significantly increased prevalence compare with people without diabetes. The risk increases with the level of glycaemia, the duration of diabetes and the number of risk factors. People with T2DM have much earlier and more extensive process of accelerated atherosclerosis, more vulnerable and larger volume atherosclerotic plaques and coronary artery lumen with a smaller diameter, compared to people without DM. The pathogenic complex is influenced by genetic factors, age, personal history and a pro-risk lifestyle (unhealthy eating, sedentary lifestyle, smoking, sleep disorders, psychosocial stress and depression) [1].

The macrovascular complications mainly refer to the atherosclerotic cardiovascular disease, represented by coronary artery disease (acute and chronic coronary syndrome) (CAD), chronic peripheral artery disease (PAD) and cerebrovascular disease (CBV). A particular complication is heart failure (HF). The pathogenic mechanisms of micro-and macro-angiopathy are extremely complex, with multiple interactions at the molecular-cellular and vascular-organic level.

Although all complications declined in the last decades, the most significant decreases in diabetes-related complications occurred for heart attack and stroke, especially for people aged 75 years and older. The CVD risk and mortality rate has declined in both the general population [2] and the people with diabetes [3]. However, diabetes, mainly T2DM, continues to be an important generator of cardiovascular disease. As the number of patients with diabetes is predicted to increase, reaching 700 million in 2045 [4], it is expected that the number of people with CVD will also increase. Thus, these major diabetes complications continue to place a heavy burden on health care systems.
